Improved prognosis in type 1 diabetic patients with nephropathy: A prospective follow-up study
Improved prognosis in type 1 diabetic patients with nephropathy: A prospective follow-up study
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DOI：
10.1111/j.1523-1755.2005.00521.x
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发表时间：
2005-09-01
影响因子：
19.6
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Astrup, AS;Tarnow, L;Parving, HH
背景资料。在早期的研究中，观察到糖尿病肾病发病后的中位生存期为5至7年。此外，终末期肾病(ESRD)是死亡的主要原因。我们前瞻性地评估了肾脏和心血管保护治疗对合并糖尿病肾病的1型糖尿病患者预后的影响。我们前瞻性地跟踪观察了199例伴有糖尿病肾病的1型糖尿病患者和192例正常白蛋白尿患者，为期10年。20世纪80年代中期开始对糖尿病肾病患者进行积极的降压治疗，而他汀类药物和阿司匹林直到2002年4月才被常规开出。主要终点是心血管死亡率和发病率。次要终点为全因死亡率和ESRD。在随访期间，79名肾病患者(40%)达到了主要终点，而正常白蛋白尿患者为19名(10%)，对数等级检验P<；0.0001。主要终点的预测因素是：肾病(危险比3.26；95%可信区间1.89至5.62)、既往事件(3.19；2.04至4.97)、年龄(1.27；1.04至1.55)和收缩压(1.13；1.03至1.24)。在肾病组，60例(30%)死亡，其中25例(42%)死于心血管原因，30例(50%)肾病患者死于终末期肾病。糖尿病肾病发病后的中位生存期估计为21.7年，SE为3.3年。糖尿病肾病患者的存活率得到改善，这很可能是由于积极的降压治疗和血糖控制的改善。
Background. In early studies, a median survival time of 5 to 7 years from onset of diabetic nephropathy was observed. Furthermore, end-stage renal disease (ESRD) was the main cause of death. We prospectively assessed the impact of reno- and cardiovascular protective treatment on prognosis in type 1 diabetic patients with diabetic nephropathy.Methods. We prospectively followed 199 type 1 diabetic patients with diabetic nephropathy and 192 patients with normoalbuminuria for 10 years. Aggressive antihypertensive treatment was initiated in patients with diabetic nephropathy in mid 1980s, whereas statins and aspirin were not prescribed routinely until April 2002. The primary end point was cardiovascular mortality and morbidity. Secondary end points were all-cause mortality and ESRD.Results. During follow-up, 79 patients (40%) with nephropathy reached the primary end point versus 19 (10%) of normoalbuminuric patients, log rank test P < 0.0001. Predictors of the primary end point were: nephropathy (hazard ratio 3.26; 95% confidence interval 1.89 to 5.62), previous event (3.19; 2.04 to 4.97), age (1.27; 1.04 to 1.55), and systolic blood pressure (1.13; 1.03 to 1.24). In the nephropathy group, 60 patients (30%) died; hereof, 25 deaths (42%) were ascribed to cardiovascular causes while 30 patients (50%) with nephropathy died with ESRD. The estimate of median survival time from onset of diabetic nephropathy was 21.7 years, SE 3.3 years.Conclusion. The survival of patients with diabetic nephropathy has improved most likely due to aggressive antihypertensive treatment and improved glycaemic control.